Provider Demographics
NPI:1376139428
Name:AUSTIN, LOREN D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:D
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3906 GRAVELINE CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506-1636
Mailing Address - Country:US
Mailing Address - Phone:704-441-0888
Mailing Address - Fax:
Practice Address - Street 1:2550 E 88TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3814
Practice Address - Country:US
Practice Address - Phone:907-349-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK167447183500000X
TX66905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist